MOGADISHU, Somalia - Islamic insurgents and Ethiopian soldiers turned the streets of the Somali capital into a battleground for a fourth straight day, firing rockets and mortar rounds at each other on Saturday in what a human rights official said was the worst violence in years.

At least 165 civilians have been killed this week's fighting, including at least 52 on Saturday as residents hid inside, cowered under trees or abandoned the city altogether.

During a journey to Mogadishu's main airport, an Associated Press cameraman saw 11 bodies in the streets - some missing limbs, others decapitated. At one point, a mortar round hit the vehicle in front of his, but everyone survived the blast.

Dahir Dhere, director of Medina hospital, said his hospital had more wounded patients than it could handle and had pitched tents outside to care for them.

Neither the insurgents nor the Ethiopian government, which sent troops to Somalia last year to oust the Islamic movement, has admitted to any casualties.

An AP reporter heard the boom of Ethiopian mortar shells fired toward northern Mogadishu, which appears to be the main battlefield between the two sides.

Residents fled their single-story homes to seek shelter on the ground floors of taller buildings, believing that the higher roofs would better absorb mortar damage, said Aden Mohamed, a former banker who had sought refuge in such a home.

At least one man found no shelter at all and instead cowered beneath a tree.

Hundreds of women, children and men walked or piled into trucks to flee to Mogadishu's outskirts or leave city, joining an exodus of hundreds of thousands who have abandoned Mogadishu since February. Those on foot Saturday carried cooking utensils, bedding and clothes on their heads. Some looked weak and said they had not eaten for days. "It is better to die in a safe place hungry and thirsty than to wait for mortar shells," said a mother of eight who only gave her name as Faduma. She said she had not eaten for two days and that her husband and eldest daughter were killed last month in fighting between the insurgents and Ethiopians. Many of the Islamic insurgents are masked and fire shoulder-held rocket launchers, Kalashnikov assault rifles or machine guns mounted on pickup trucks. Ethiopian soldiers normally fight from public spaces such as intersections or government buildings. Somalia's Elman Human Rights Organization said Mogadishu residents, hospital workers and human rights workers reported at least 52 civilian deaths and an unknown number wounded Saturday. The new tallies bring the death toll in four days of fighting in Mogadishu to at least 165, according to the rights group. Saturday's violence is the worst in recent years, said Sudan Ali Ahmed, Elman's chairman. The U.S. Ambassador to Kenya and Somalia, Michael Ranneberger, blamed the violence on clan rivals and remnants of the ousted Islamic movement. "They are trying to create an insurgency," Ranneberger told the AP from Kenya. "But at this point it's opportunistic violence. They're not organized like an insurgency." Somali troops backed by Ethiopian forces ousted the Council of Islamic Courts from Mogadishu and other strongholds in December. Since then the capital has seen of waves of violence. Somalia's transitional government was formed in 2004 with U.N. help, but has struggled to extend control over a country mired in anarchy for nearly two decades.